As an oncologist, perhaps the hardest part I play is as witness. I am there to give a diagnosis that, more often than not, will alter someone’s life forever. For some, I see resignation—a sense that they’ve known something was wrong and that it’s what they thought they had. For others, I see an almost …
As an oncologist, this is the hardest role I play
One of the most valuable jobs I held following fellowship was working as a full-time deputy editor at UpToDate. My “territory” was breast, gynecologic, and genitourinary oncology, and I helped launch cancer survivorship and palliative care. I learned to really and critically read the literature, and how I could summarize it quickly so that my …
Why physicians should acknowledge the validity of second opinions
As a doctor, there is an experience that all can relate to. It concerns that particular patient who comes in with not just one concern, but a litany of them. They require more than the prescribed 15 minutes of visit time, and we sit and listen, try our best to console and guide. Yet, for some patients, it never seems …
A patient who taught an important lesson in doctoring
I am a firm believer that medicine is best practiced as a team, with the one undergoing treatment at the center participating fully. It’s a belief embedded in the multidisciplinary care model. I have been fortunate to have been exposed to multidisciplinary clinics in my fellowship at Memorial Sloan Kettering Cancer Center and have worked …
Including the patient perspective on tumor boards
As an oncologist, I have seen the devastating impact of being told one has cancer. The reaction I most often see among my patients is fear that they’ve been given a death sentence, an urgent need for a plan, and hope that they will survive. I often want patients to know I too sense their …
The devastating impact of being told one has cancer
While it would be ideal if all of our decisions in medicine were based on clear and definitive data, that isn’t the case, for most of what we face with our patients. Data is open to interpretation, studies can always be criticized, and the results are not always clear. Still, as clinicians we must help our …
Why multidisciplinary and coordinated cancer care matters
I was driving to work one morning, and as part of my new routine, I listen to The Moth podcast. If you do not know it, it’s a wonderful community of storytellers — compelling stories, told by people from every walk of life. I often find myself drawn into the program (like a moth …
When patients die, physicians mourn as well
In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to …
How clinicians can impede clinical trial recruitment
In an era where health information is freely flowing thanks to the internet and Dr. Google, I’ve come to expect that patients who see me for the first time will have done their homework — about their cancer, treatment options, and yes, even about me. To be frank, it’s not uncommon for patients to mention they’ve …
Accept the decisions patients make
Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s …
Cross-coverage has made me aware of the art in medicine
I’ve written in the past about how words are powerful — that they can have multiple meanings, how they can change depending on context. I am often reminded of how true that is in everyday oncology practice, especially when it comes to meeting new patients. Some are diagnosed with cancers that carry a relatively good prognosis, …
Words are powerful. Use them carefully.
Medicine is an honorable profession. We meet people at a vulnerable point in their lives — when it comes to cancer, it is often at their most vulnerable. In oncology, care is typically multidisciplinary, and one of the most important advances in my own professional career has been this team approach. To see a patient with …
Patients can live with metastatic cancer
Part of the challenge in oncology is the balance between hope and reality, and that is probably the most important thing to strive for for patients living with metastatic disease. Often times, the important conversations relate to treatment options, goals of care, and patient preferences (i.e., how frequent the visits to the doctor and for …
The challenge in oncology: balancing hope and reality
I have been fortunate enough to find a home in academic medicine. Most of that time I’ve spent in oncology — working with residents, fellows, and colleagues on projects, whether they be chart-based or prospectively designed trials. I’ve lectured a ton, and written even more. Yet, my experience in academia has also allowed me to …
What makes a great doctor: a physician reflects
I consider myself lucky to be the father to three wonderful kids: My oldest is now 15 and my twins are 9. They are indeed the light of my life. I get asked every so often, why did you want kids? It is a fair question, I suppose. After all, my partner and I relied on …
The power of family at the end of life
As an oncologist, I want to provide the best treatment for everyone. That should mean the best chance at a long-lasting remission, if not cure. Whatever that might take. Surgery, chemotherapy, radiation therapy — a dark tunnel that I hope patients will enter and then exit, with the sun shining on the other side. But, every …
Doctors have a responsibility to outline options. Patients make the final decision.
Starting a new job is always stressful — the move from one institution to another, getting hospital credentials, obtaining provider credentialing for various insurances, meeting new staff, and adjusting to a new work “culture”. Having done my share of moves, these are nearly universal experiences. However, as I find myself walking around the hallowed halls …
Saying goodbye shows how strong doctor-patient bonds can be
I was reading my emails this morning and came across one from the Foundation for Women’s Cancers, announcing September as Gynecologic Cancer Awareness Month. Their social media campaign centered on the hashtag #sharethepurplelove, and the focus on clinical trial awareness and participation. It got me thinking again about the enterprise of clinical trials, and just …
Experimental treatments: When patients want something outside of standard of care
I’d known her for almost 3 years. She had advanced ovarian cancer — clear cell — and was diagnosed with disease already in her chest, stage IV. She had a terrific response to neoadjuvant chemotherapy, which had resolved her extra-abdominal disease sites after three cycles. She had an aggressive interval surgery which achieved complete resection …
A cancer patient’s incredible response to treatment
I remember meeting this patient the first time. I had just started in a new position, and she was one of my first consults. Tracey* had an aggressive sex-cord tumor of the ovary that had relapsed soon after surgery, grown through primary chemotherapy and grew once more after secondary surgery and “adjuvant” pelvic radiation. I knew …
Are end-of-life decisions the doctor’s or the patient’s?
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